[Short fusion and long fusion for degenerative lumbar scoliosis with lumbar stenosis].

Objective: To explore the indications, surgical techniques and prognostic factors of short fusion versus long fusion for elder patients with degenerative lumbar scoliosis.
Methods: Thirty-eight patients undergoing different kinds of surgical procedures for lumbar spinal scoliosis between June 2005 and October 2010 were recruited for this retrospective study. The mean patient age at surgery was 64.2 years (range: 61 - 75). The short fusion group included 13 patients and the long fusion group 25 patients.
Results: There were a variety of treatment methods of degenerative scoliosis based on the symptomatology and radiological measurements of scoliosis and stenosis. Thirty-eight patients were followed up for an average of 37 months. The number of fused levels was 2.8 ± 0.7 segments in the short fusion group versus 5.1 ± 1.4 in the long fusion group. The average preoperative Cobb angle was 18.6° (range: 12 - 27) in the short fusion group versus 33.5° (range: 3 - 42) in the long fusion group. The correction of Cobb angle averaged 40% in the short fusion group versus 67% in the long fusion group. Clinical symptoms and functional tolerance for daily activities improved postoperatively. Radiographic evaluations showed reduced deformity on the frontal and sagittal planes. There were no infections, pseudoarthrosis, instrument-related failures or reoperations.
Conclusions: Long segment fusion is superior to its short segment counterpart in correcting scoliotic curvature and coronal imbalance and improving rotational subluxation of apical vertebra. Careful perioperative preparation is essential in the treatment of elder patients with lumbar spinal scoliosis.